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5Using robot technology to analyze forces and torques in tooth removal 79IntroductionIn 1952, Captain Donald Kitzis from the Dental Corps of the United States Army stated that ‘exodontia, as a scientific field of endeavor, has been sadly lacking in fundamental precepts’ and closes his article hoping that ‘this article will stimulate some thought along these lines in order that the practice of exodontia be placed on a more scientific foundation’ [1]. Being one of the oldest en most frequently performed invasive procedures; the lack of scientific progress of tooth removal procedures is impressive. Since then, only several papers have been written on this subject, measuring forces in limited ways and only on a selection of teeth on either animals [2], patients [3, 4] or more recently, in a laboratory setting [5]. Measurements of torques (rotational forces) are mostly absent and, together with the limited available data on forces, leads to a strong limitation in our scientific understanding of tooth removal procedures. The existing knowledge gap has its influence on the quality of education and previous efforts closing it had mostly educational purposes in mind [3, 5]. With strong evidence-based education being absent a wide variety of educational approaches are currently practiced, ranging from readers and cadaver training to none at all, in which students practice on patients from the start [6, 7]. Especially in developed countries, due to the successes of preventive dentistry, the possibility to practice on patients has been reduced, leading to less confidence among young dentists and an increase in unnecessary referrals to maxillofacial surgeons [6, 8]. This is in contrast to other aspects of dental training such as restorative dentistry, for which sophisticated training modalities have been developed, ranging from virtual training with haptic feedback [9] to robotic patient simulators [10, 11]. The scientific evidence for most initiatives where robot technology is deployed in dentistry, including educational purposes, should be considered as low [12]. The goal of this project is to capture both forces and torques exerted during tooth removal in clinically relevant dimensions and high detail by using, amongst others, robot technology. The results of a series of experiments on fresh-frozen cadavers are presented in a descriptive manner and could improve our scientific understanding of these procedures. Tom van Riet.indd 79 26-10-2023 11:59